Nursing Home Information & Litigation

The New York Times reported that Federal investigators say they have found evidence of widespread overuse of psychiatric drugs by older Americans with Alzheimer’s disease, and are recommending that Medicare officials take immediate action to reduce unnecessary prescriptions. Experts have raised concern about the use of antipsychotic drugs to address behavioral symptoms of Alzheimer’s and other forms of dementia. The Food and Drug Administration says antipsychotic drugs are often associated with an increased risk of death when used to treat older adults with dementia who also have psychosis. Antipsychotic drugs are expensive, costing hundreds of millions of Medicare dollars. They also increase the risk of death, falls with fractures, hospitalizations and other complications.

The findings by the Government Accountability Office, said officials needed to focus on overuse of such drugs by people with dementia who live at home or in assisted living facilities. The Department of Health and Human Services “has taken little action” to reduce the use of antipsychotic drugs by older adults living outside nursing homes, the report said. Doctors sometimes prescribe antipsychotic drugs to calm patients with dementia –often in nursing homes that had inadequate numbers of employees.

Senator Susan Collins, Republican of Maine and chairwoman of the Senate Special Committee on Aging, who with Mr. Carper requested the study, said, “The report raises many red flags concerning the potential misuse and excessive use of antipsychotic drugs for patients with Alzheimer’s and other dementias.”

Toby S. Edelman, who represents patients as a lawyer at the Center for Medicare Advocacy, said, “We could save money and provide better care if nursing homes reduced the inappropriate use of antipsychotic drugs.”

A Chicago psychiatrist pleaded guilty last month to taking illegal kickbacks of nearly $600,000 to prescribe an antipsychotic drug for his patients. The doctor, Michael J. Reinstein, also agreed to pay $3.79 million to the federal government and the State of Illinois to settle a lawsuit asserting that he had been involved in the submission of at least 140,000 false claims to Medicare and Medicaid. Law enforcement officials said he had prescribed clozapine for thousands of older and indigent mentally ill patients at 30 nursing homes and other sites. The lawsuit said drug companies had paid kickbacks, consulting fees and entertainment expenses for Dr. Reinstein as part of an effort to induce him to write prescriptions for clozapine. Last March, Teva Pharmaceuticals Industries and a subsidiary, IVAX Pharmaceuticals, agreed to pay $27.6 million to settle allegations that they had violated federal and state False Claims Acts by making payments to Dr. Reinstein.

NJ Online had a great article about protecting loved ones from elder abuse quoting esteemed nursing home advocate/attorney Saul Gruber. Our senior citizens are the heart of the population, but are often times forgotten when placed into long-term care facilities.

“The nursing homes get to a point where they are trying to make money and the biggest expense is labor, so that’s where they make cuts,” Gruber said. “Understaffing is the biggest problem. The employees are OK, but they can only do so much. If they are told to feed eight people at each meal, but those eight turn into 14, it’s tough.”

Federal guidelines were first put into place in 1987, Gruber said. “Everything was put on paper,” he said. “Everything they had to do to maintain patient care. They know what they’re supposed to do. The problem is they aren’t doing it.”

Signs of elder neglect or abuse

Bed sores – Pressure ulcers or bedsores occur when a patient is not being moved often enough and not being fed a proper diet, according to Gruber. “We see those a lot,” he said of neglect cases. “I call them rotting, smelly holes in someone’s back.”

Falls – Gruber said it is the staff’s responsibility to do whatever is necessary to prevent falls. “There are a lot of things they can do,” he said. “If they fall out of bed, be sure the bed is near the wall. Use rails. If person seems to fall at 3 a.m., maybe take them to the bathroom at 2:30 a.m. so they don’t have to get out of bed. They are supposed to try to prevent falls. Prevention is key.”

Strange smells – Gruber suggests conducting a “smell test.” “Bad smells are a give-away for many different issues,” he said. “Even if it’s a very antiseptic feel and smell, it’s not really a home, and what is that smell covering up?”

Tips

Care assessments – When a patient is admitted to a long-term facility, staff members are required to perform a “care assessment.” “They should be assessed so the staff knows what they need, what problems they have, and how to care for them,” Gruber said. “These assessments need to be done all the time because patients change.” Care assessments look for a patient’s “red flags” – such hazards as falling due to instability, pressure ulcers due to lack of movement, choking, and malnutrition.

“Then they are supposed to make up a care plan – it’s not magic,” Gruber said. “What are they at high risk for? And here’s what to do to prevent these issues and care for the patient.” Then, that plan must be utilized faithfully.

“If a care plan is put into place to prevent falling and the patient continues falling, the staff can’t just say ‘oh well.’ They have to do more,” he said.

Be familiar with the staff – Gruber said, once your family member is settled, get to know the staff members who will be caring for your loved one.

“When you put someone into a facility, you have to become friendly with the staff because they will tell you what’s happening,” he said.

Vary your visitation – If a patient is being neglected or abused, staff members may pay attention to when the the family comes in and be sure that the situation looks perfect.

“Go visit at different times of the day,” Gruber said. “Don’t always go at 3 p.m. and don’t tell them when you are coming, and just see what’s happening.”

Check online – Gruber said medicare.gov publishes reports on the performance of each of the approximately 300 nursing homes throughout the state.

“Each nursing home has to be inspected a minimum of once per year,” he said. “It’s called a survey. They pull random charts, and interview staff and families, to make sure doing what they are supposed to be doing.” These reports can show you what areas a facility has had problems with.

“When picking, look online at reports,” Gruber said. “If you think you don’t like a nursing home, don’t go there. If you’re already there and think something is wrong, it probably is.” Gruber said the most import aspect is being present.

“You’ve got to be there,” he said. “some families are afraid that if they raise trouble, then when they are not there, their loved one won’t be cared for properly. Let (staff) know you will know if they neglect the patient.”

He said one of the most difficult parts of his job is dealing with a family’s guilt.

“I’ve sat here with clients crying, saying, ‘Why did I put my mom there? I knew it was bad and now she’s dead,'” Gruber said.

JAMDA had an article on ” Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States”. Below is the Abstract.

Abstract

Objectives

To identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system.

Design

Retrospective analysis of the 2005–2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) with those that led to admission (less likely preventable).

Setting

Nationally representative sample of US EDs; federal hospitals and hospitals with fewer than 6 beds were excluded.

Participants

Older (age ≥65 years) NH residents with an ED visit during this time period.

Measurements

Results

Older NH residents accounted for 3857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing before ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively,P < .001), whereas infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). Computed tomography (CT) scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications before ED discharge in 9.4% of visits.

Conclusion

This nationally representative sample of older NH residents suggests ED visits for injury, those that are associated with normal triage vital signs, and those that are not associated with any diagnostic testing are potentially preventable. Those discharged from the ED often undergo important testing and receive medications that may alter their physical examination on return to the nursing facility, highlighting the need for seamless communication of the ED course to NHs.

Here’s eye-opening news: Currently, 4.2 million Americans ages 40 and older are visually impaired. Of these, 3 million have low vision. By 2030, when the last baby boomers turn 65, the number of Americans who have visual impairments is projected to reach 7.2 million, with 5 million having low vision.

For the millions of people who currently live or will live with low vision, the good news is there is help. But first, what is low vision? Low vision is when even with regular glasses, contact lenses, medicine, or surgery, people have difficulty seeing, which makes everyday tasks difficult to do. Activities that used to be simple like reading the mail, shopping, cooking, and writing can become challenging.

Most people with low vision are age 65 or older. The leading causes of vision loss in older adults are age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma. Among younger people, vision loss is most often caused by inherited eye conditions, infectious and autoimmune eye diseases, or trauma. For people with low vision, maximizing their remaining sight is key to helping them continue to live safe, productive, and rewarding lives.

The first step is to seek help.

“I encourage anyone with low vision to seek guidance about vision rehabilitation from a low vision specialist,” advises Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute (NEI), one of the National Institutes of Health (NIH) and the federal government’s principal agency for vision research.

What is a low vision specialist? A low vision specialist is an ophthalmologist or optometrist who works with people who have low vision. A low vision specialist can develop a vision rehabilitation plan that identifies strategies and assistive devices appropriate for the person’s particular needs. “A vision rehabilitation plan helps people reach their true visual potential when nothing more can be done from a medical or surgical standpoint,” explains Mark Wilkinson, O.D., a low vision specialist at the University of Iowa Hospitals and Clinics and chair of the low vision subcommittee for the National Eye Health Education Program (NEHEP).

Vision rehabilitation can include the following:

Training to use magnifying and adaptive devices

Teaching new daily living skills to remain safe and live independently

Developing strategies to navigate around the home and in public

Providing resources and support

There are also many resources available to help people with low vision. NEI offers a 20-page, large-print booklet, titled What You Should Know About Low Vision, and companion DVD, featuring inspiring stories of people living with low vision. This booklet and DVD, among other resources, are available at www.nei.nih.gov/lowvision.

With the aging of the population, eye diseases and vision loss have become major public health concerns in the United States. NEI is committed to finding new ways to improve the lives of people living with visual impairment. Aside from making information and resources readily available, NEI has dedicated more than $24 million to research projects on low vision, including learning how the brain adapts to vision loss; strategies to improve vision rehabilitation; and the development of new technologies that help people with low vision to read, shop, and find their way in unfamiliar places. Research like this will help people with low vision to make the most of their remaining vision and maintain their independence and quality of life.

The Wall Street Journal had an interesting article about surgical errors in hospitals. Surgery can be risky by its very nature, and the possibility of error or negligence makes it even more so. According to an analysis last year in the journal Patient Safety in Surgery, 46% to 65% of adverse events in hospitals are related to surgery, especially “complex” procedures. Procedures are still performed on the wrong body part and surgical tools are sewn up in patients.

The consequences of surgical error are huge, both for patient health and hospital finances. A 2012 study by researchers at Johns Hopkins estimated that there are 4,082 malpractice claims each year for “never events”—the type of shocking mistakes that should never occur, like operating on the wrong body part. In nearly 10,000 cases studied, which took place from 1990 to 2010, never events led to death in 6.6% of patients, permanent injury in 32.9% and temporary injury in 59.2%. The total payout in those cases was $1.3 billion.

“Given all of the current technology, strategies and tools that are available to prevent these occurrences, it is unacceptable that foreign objects are still being left in surgical sites and that wrong-site surgeries are still occurring,” says Lisa Freeman, executive director of the nonprofit Connecticut Center for Patient Safety. Many hospitals are participating in the National Surgical Quality Improvement Project, or NSQIP, overseen by the American College of Surgeons and adapted from an effort at Veterans Administration hospitals that helped decrease postoperative death rates by 47% from 1991 to 2006. “All too often, patients are being harmed by preventable complications,” says Clifford Ko, a colorectal surgeon at UCLA and director of NSQIP. Many hospitals don’t collect reliable data on their own adverse events, and “you can’t improve a hospital’s surgical quality if you can’t measure it.”

There’s also a movement afoot to change how some surgeons behave. Often seen as the rock stars of medicine, surgeons can be hard to rein in, resisting efforts to conduct preoperative briefings and being dismissive and curt if not downright intimidating to underlings. According to a study in the American Journal of Surgery in January, they are the specialists most commonly identified as “disruptive physicians,” and their outbursts can shift the focus away from the patient and lead to increased mistakes during procedures and diminished respect from colleagues.

ABC Chicago reported that Illinois may become the next state to allow video security of nursing home residents. The ABC7 I-Team reported last spring that cameras are legal in four states. Ten months after an ABC7 I-Team investigation of nursing home abuse, legislation was introduced in Springfield that would help family members who want to keep closer watch on their loves ones. Under the proposal, surveillance cameras could be put in the rooms of nursing home patients.

Health care experts and family members of nursing home residents say that surveillance cameras would help keep elderly patients safe, improve the state’s nursing home care ranking, which is near the bottom nationally, and save taxpayer money from being wasted.

The latest Department of Public Health report cites 106 Illinois nursing home residents were victims of theft, abuse and neglect.
“If we can prevent 10 percent, 20 percent, 50 percent of the suffering of these seniors by making sure they are recorded and people know that their actions will be seen, it would be a wonderful thing,” said Rep. Greg Harris (D-Chicago). Rep. Harris says Attorney General Lisa Madigan asked him to draft legislation. Under the proposed law:

Nursing home cameras would have to be visible

Resident’s roommates and staff notified in advance

Patients would be responsible for paying

“Having eyes on the patients, being able to have a clear record of what goes on, should enable guaranteed better care and it should protect them if they’re concerned that somebody make a frivolous charge,” Rep. Harris said. Under the law, the state would put up $50,000 for residents who couldn’t afford cameras, recipients to be chosen by lottery.

The New York Times reported changes to the Nursing Home Compare website on CMS.gov. The federal government announced that it was changing the way it measures nursing homes, essentially adjusting the curve that it uses to rate homes to make it more difficult for them to earn coveted four- and five-star government ratings. Under the changes, scores are likely to fall for many homes, federal officials said, although they did not provide specific numbers.

“In effect, this raises the standard for nursing homes to achieve a high rating,” said Thomas Hamilton, the director of the survey and certification group at the Centers for Medicare & Medicaid Services, which oversees the ratings system. Nursing homes are scored on a scale of one to five stars on Nursing Home Compare, the widely used federal website that has become the gold standard for evaluating the nation’s more than 15,000 nursing homes even as it has been criticized for relying on self-reported, unverified data.

In August, The New York Times reported that the rating system relied so heavily on unverified information that even homes with a documented history of quality problems were earning top ratings. Two of the three major criteria used to rate facilities — staffing levels and quality measures statistics — were reported by the homes and not audited or verified by the federal government.

In October, the federal government announced that it would start requiring nursing homes to report their staffing levels quarterly — using an electronic system that can be verified with payroll data — and that it would begin a nationwide auditing program aimed at checking whether a home’s quality statistic was accurate.

The changes were part of a further effort to rebalance the ratings by raising the bar for nursing homes to achieve a high score in the quality measures area, which is based on information collected about every patient. Nursing homes can increase their overall rating if they earn five stars in this area. The number of nursing homes with five stars in quality measures has increased significantly since the beginning of the program, to 29 percent in 2013 from 11 percent in 2009.

The updated ratings will also take into account, for the first time, a nursing home’s use of antipsychotic drugs, which are often given inappropriately to elderly patients with dementia.

IJ Review had the story and video of a resident being abused by caregivers. In 2012, video evidence surfaced showing a brutal abuse of an elderly woman by two aides at a nursing home in Oklahoma City. Jurors awarded the woman’s family $1.2 million for emotional distress with an additional $10,000 in punitive damages, KOCO reports.

At Quail Creek Nursing and Rehabilitation Center in Oklahoma, two aides shoved latex gloves down the throat of Eryetha Mayberry while she sat helplessly in her wheel chair. Wes Bledsoe, an advocate for reforms in nursing homes, discussed the harrowing footage:

“In my mind, there’s absolutely no question that these aides had abused other residents before this… This was not the first time that they had ever abused a resident and if it had not been for that camera they would have continued to abuse other residents.”

Lucy Waithira Gakunga and Caroline Kaeseke, the two women caught abusing Mayberry, were found guilty of abuse. Kaeseke is rumored to have fled the country while Gakunga served two years and was subsequently deported for her crimes.

Mayberry passed away less than six months after the abuse took place. She was 96 years old and suffered heavily from dementia and Alzheimer’s disease.

The NY Post reported that a settlement has been reached in the seven year case involving a resident who froze to death. Prospect Park has agreed to settle the wrongful death lawsuit filed by his family for $750,000 — while the home’s half-dozen remaining residents still suffer in freezing temperatures, according to court papers and a lawyer for the judge’s family. The late Civil Court Judge John Phillips — known in his heyday as “the kung-fu judge” because of his black belt — froze to death in his Prospect Park Residence apartment, court papers state. “Judge Phillips froze to death while confined to an unheated apartment at the defendants unlicensed facility in February 2008,” according to court papers filed by Phillips’ estate in 2010.

“The judge’s wrongful death is not an isolated incident,” said lawyer John O’Hara, who represents the Phillips estate. “He was confined and they were blocking doctors from seeing him and the heat went off and he froze to death seven years ago today. And there are still people freezing in there.”

An elderly woman who currently lives in the facility said the dining room and other common rooms are unheated and that the residents often eat in their rooms so they don’t have to brave the freezing dining room. “It was really bitter cold [at breakfast this morning.] My fingers were like ice. They had a little space heater but it didn’t generate any heat,” said the woman, who didn’t want her name used because she fears retaliation.

The Saratogian News reported that a long-time employee and relatives of residents at the former Maplewood Manor nursing home disclose that residents aren’t being fed, bathed and cared for properly since new owners took over on Feb. 1. The employee states that residents were verbally and physically abused by one of the nearly three dozen temporary agency workers brought in from New York City to fill staffing shortages. But another person said medicine wasn’t administered in a timely manner to their family member, and that the facility ran out of bibs and wash cloths last weekend. “I watched an aide use disposable paper ones,” the person said. “My family member cried out like it was sandpaper.” A current long-time employee said patient alarms sometimes aren’t attached, food is simply left with residents that need assistance eating, and residents who previously were changed and put to bed by early evening are still in wheelchairs — wearing urine-soaked diapers — close to midnight. “Since it switched over there’s been a lot of neglect,” the employee said. “I blame it on these agency people and I blame it on Zenith because they weren’t prepared (for the changeover).”

The principal owners of Long Island-based Zenith Health Care Group, Ari Schwartz and Jeffrey Vegh, purchased Maplewood Manor from Saratoga County for $14.5 million. The facility has been renamed Saratoga Center for Rehabilitation and Skilled Nursing Care. Since the ownership change pay has been reduced from about $21 to $15.10 per hour, that employee healthcare contributions have gone up and that it takes longer to become eligible for sick time and vacations. One employee resigned this week, in part because the workload had become too great.

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